Disaster Recovery Operations

This commentary appeared on The Health Care Blog on May 21, 2013.

Monday's massive tornado ripped through Moore, a suburb of Oklahoma City, devastating homes and businesses and killing at least two dozen people. The disaster came just over a month after an explosion at a fertilizer plant devastated the town of West, Texas, killing 15 people and injuring some 200 others. Just two days earlier the bombings at the Boston Marathon left three dead and more than 260 injured.

Three mass-casualty events occurring in three very different settings show that disaster preparedness should not be limited to large cities or “target” areas in the United States. One trait that is common to all such events—whether urban, suburban or rural—is the need for coordinated, responsive trauma care for victims.

This commentary appeared in New England Journal of Medicine on April 24, 2013.

At 2:50 p.m. on April 15, nearly 3 hours after the first runner completed the Boston Marathon, two blasts ripped through the crowd that was gathered along the approach to the finish line, killing 3 people and injuring more than 260. Within moments, the crowd's initial panic was replaced by purposeful action, as bystanders ran to, rather than from, the horror to help the injured. Law-enforcement and emergency medical services (EMS) personnel swiftly converged on the scene. Within minutes, ambulances began transporting the most critically injured to nearby hospitals....

The remainder of this op-ed can be found at nejm.org.

It wasn't just a storm, but a superstorm that ravaged America's Northeast last October. And recently, parched earth became charred earth as wildfires blazed anew in Colorado.

More superstorms and drier droughts are consistent with the expected impacts of climate change, so that such impacts may become more common over time. Difficult-to-predict, ever changing conditions may become our new normal.

The question is: How do we respond, in our homes and in our communities, to climate change challenges amid such uncertainty?

On the eve of Earth Day, we suggest the path to climate change preparedness should start at the intersection of resilience and robustness — that is, building resilient communities with the individuals and organizations within those communities making robust decisions, ones designed to work well over a wide range of ever-changing conditions.

This commentary appeared on Health Affairs Blog on December 21, 2012.

The horrific massacre of 27 children and adults in Newtown, Connecticut ranks second only to Virginia Tech among U.S. mass shootings. These tragedies are part of a lengthening list of mass killings in such varied places as a shopping mall, a movie theater, a Sikh Temple, a high school, a congressional constituent meeting, and a military base. But this one was different. Not only were the death toll particularly high and the killings particularly savage; the killer's victims were first-grade students, teachers and school staff.

Millions are deeply touched by this tragedy, but few of us can fathom the shock and grief felt by the survivors, parents, family members and friends of those who died. Our first concern must be to comfort them and support what will likely be a long and difficult recovery. But few people are prepared to stop with that. This event, unlike its predecessors, has sparked a movement to challenge the inevitability of mass shootings, not to mention the thousands of individual gun homicides that occur each year in the United States.

I've spent much time since Friday imagining the unimaginable—little children murdered in the place that is supposed to be their home-away-from-home, their elementary school. The media fed my curiosity. I could not stay away from checking the news and blogs hourly, despite my family's pleas to stop reading and my own knowledge that it can be too much to read so many details, see so many pictures, grieve from afar.

It's because I want to help. I am a psychologist, and this is why I went into the profession and made trauma my focus. I know from a vast amount of research that many of those touched by Friday's shootings will experience a great deal of distress in the weeks and months ahead. But they will, somehow, miraculously, find a pathway forward to health and productivity. And I am reassured that over the past 15 years or so, we have developed a wide array of practices, procedures, and interventions that are well-tested and helpful for those children that will take longer to recover.

As the East Coast continues to rebuild a month after the devastation of Hurricane Sandy, it's important to bear in mind that this latest confluence of storms is merely one in a potential string of disasters that the region and the nation may confront due to changes in climate and other threats. As New York's Governor, Andrew Cuomo, recently wrote, "Extreme weather is the new normal."

This new normal calls for new strategies and approaches to helping individuals and communities rebuild after disasters. Fortunately, history holds lessons that can help us adapt and adjust to our new future.

Recent global disasters, from hurricanes, to tsunamis, to powerful earthquakes, vividly illustrate that recovery from disasters entails more than simply restoring physical infrastructure such as roads and buildings; it is also a long process of restoring the social infrastructure—the daily routines and networks that support the physical and mental health and well-being of the population.

When Hurricane Katrina roared into the Gulf of Mexico in August 2005, New Orleans was ill prepared for what followed. When storm-weakened levees failed the following day, the ensuing flood inundated large parts of the city, including several hospitals. Charity Hospital, a massive 2,680-bed facility, quickly lost power because its backup generator drowned in the hospital's basement.

Fast forward seven years. As Hurricane Sandy bore down on coastal New Jersey and New York City, officials thought they were ready. NYC Mayor Michael Bloomberg had received assurances from the city's hospitals that they could function on their own in the event of a power outage. But when storm surge swept through areas of lower Manhattan, two of the city's most vital hospitals—NYU-Langone and Bellevue—shut down. The reason? Critical components of both hospitals' backup power supplies—including a generator and fuel tanks at NYU-Langone, and fuel pumps that fed Bellevue's generators 13 floors up—were submerged in their basements. Ultimately, more than 700 patients had to be evacuated from the two facilities.

As we wrote in August, "Preparing for natural disasters is a long, multi-faceted process. It shouldn't stop when hurricane season ends and indeed requires years of planning, coordination, and direct action."

In preparation for Hurricane Sandy's arrival, individuals stocked up on batteries and supplies, power companies brought in extra crews from out of state and in some cases cut power to protect transmission equipment, and governors declared preemptive states of emergency and ordered mandatory evacuations for high-risk areas, such as barrier islands.

This commentary appeared in USA Today on May 23, 2012.

A year ago this week, a deadly tornado tore through Joplin, Mo., killing 161 people. The twister also heavily damaged St. John's Regional Medical Center, sucking up patient files and X-rays and depositing them up to 70 miles away. Fortunately, barely three weeks earlier, St. John's had switched from paper to electronic health records.

No one could have predicted the destruction ahead, or the benefits the electronic records would quickly provide. Even as the hospital's 183 patients were being evacuated, St. John's staff accessed and printed out their records from a remote site, and sent copies with patients to hospitals where they were transferred.

Fortunately for the national capital region, Hurricane Irene and the East Coast earthquake proved to be relatively minor events, as far as disasters go. There was some damage, and there have been no reports of serious injuries or deaths in the Washington area from either event.

But before everyone breathes a sigh of relief and resumes their daily routines, it would be wise to reflect on how people responded to what were, at the end of the day, dress rehearsals for much bigger events. If we fail to do that, we will miss an invaluable opportunity to draw valuable lessons.